Emergency peripartum hysterectomy

Abstract

A total of 54 166 mothers delivered at the Riyadh Armed Forces Hospital between 1990 and 1997, including 6119 (11.3%) caesarean sections. Emergency peripartum hysterectomy for obstetric haemorrhage was carried out in 16 cases (0.3/1000 deliveries). The operation followed major degrees of placenta praevia in 12 (75%) cases and atonic postpartum haemorrhage in four (25%). All patients required blood transfusion. There was one neonatal death and no maternal deaths. Although the operation was straightforward, bladder injury occurred in five (31%) cases which was repaired with no residual damage. Placenta accreta was confirmed histologically in 12 (75%) patients. In conclusion, all obstetricians should be aware of the strong association between a scarred uterus, placenta praevia and placenta accreta which can be very adherent and difficult to remove causing bleeding and necessitating hysterectomy. The operation should be performed by an experienced obstetrician before the patient's condition is extreme.

Prevalence, Indications, Risk Indicators, and Outcomes of Emergency Peripartum Hysterectomy Worldwide

“…1 By the 1950s, it had become an elective procedure (including for sterilization) and became controversial as a result of the risk of blood loss and urinary tract injury. A (previous) cesarean delivery is associated with a higher risk of emergency peripartum hysterectomy.…”

“…Interstudy heterogeneity was assessed using x 2 test for heterogeneity. 1,[4][5][6]9,10,[91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110] Two studies were analyzed as one (same sample), 4,113 so the total number of papers was considered 128. Pooled odds ratio (OR) with 95% CI was calculated for categorical variables.…”

“…1,6,17,19,20,[23][24][25][26][27][28][29]31,33,34,37,38,40,41,43,[45][46][47][48][49][50][51][52][53]57,58,60,62,64,72,78,83,86,87,93,94,96,[105][106][107][108][109]112,114,[118][119][120][121]…”

Obstetric hysterectomy: A review of cases over 16 years

“…The first documented postpartum hysterectomy took place in the USA by Horatio Storer in 1866, but the patient died three days later (Mesleh et al 1998). It is considered as one of the most risky and dramatic operations in modern obstetrics, the rate of which ranges from 0.2 per 1,000 deliveries (Engelsen et al 2001;Gardeil et al 1995;Yoong et al 2006;Bakshi and Meyer 2000) up to 8 per 1,000 obstetric consultations (Vázquez et al 2008), while maternal mortality ranges from 0 to 29.8% (Baskett 2003).…”

Maternal Outcome in Emergency Peripartum Hysterectomy: Minimizing the Risks

“…The frequency of EPH in the present study is 1.9 per 1000 deliveries which is different from those quoted from other regions of Saudi Arabia. 4,5 The highest rates of 2.5 to 5.4 per 1000 have been reported in Asia and Africa and lowest of 0.17 to 1.9 per 1000 deliveries in North America, Central Europe and Middle East. [6][7][8] Our EPH incidence is similar to that reported from developed countries as a result of good antenatal services, availability of efficient transport and blood bank services, a very high accountability and reluctance on the part of the patient to give a consent for hysterectomy.…”